Utilization Review Manager Salary in Oceanside, California

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Average Salary for Utilization Review Manager in Oceanside, California

The average salary of a(n) Utilization Review Manager in Oceanside, California is $50,283.

The average hourly rate of a(n) Utilization Review Manager in Oceanside, California is $24.17.

The average bonus of a(n) Utilization Review Manager in Oceanside, California is $1,649.00.

Job Description:

Manages a department responsible for the determination of medical necessity and appropriateness of care based on predetermined criteria and/or guidelines. Manages the utilization review function to ensure accurate and timely prior authorization of designated healthcare services, concurrent review, and retrospective review activity. Typically requires licensure as a Registered Nurse with clinical and managed care experience. Hires, develops, and motivates a qualified utilization review department staff. Plans, organizes, implements, and evaluates departmental outcomes. Performs regular data analysis of hospital census, authorization information, and medical cost reports to identify variances and root causes so that areas of focus may be identified and resources may be appropriately deployed. Ensures that benefits and policies are properly interpreted and that care is rendered in the most appropriate site of service with a focus on quality care and cost efficient outcomes. Assures timely response to provider requests for services per department standards. Conducts regular clinical reviews for utilization management activities based on guidelines and standards for patients in a variety of settings. Prepares and manages the departmental budget. Less

Manages a department responsible for the determination of medical necessity and appropriateness of care based on predetermined criteria and/or guidelines. Manages the utilization review function to ensure accurate and timely prior authorization of designated healthcare services, concurrent review, and retrospective... More

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